To code for spinal excisions and decompression procedures, coders must break down provider documentation to determine the surgical approach utilized and surgical specialists involved, and in some cases, visualize how the procedure was performed across multiple levels of the spinal column.
Julian Everett, RN, BSN, CDIP , details the updated pediatric sepsis recommendations presented by the Surviving Sepsis Campaign which provides insight for clinical documentation specialists and inpatient coders on current clinical practices for the treatment of pediatric severe sepsis and septic shock.
Q: Is there is any guidance on ICD-10-CM reporting for screening for COVID-19? For example, a patient was admitted with pneumonia and the physician documented “COVID-19 screening completed–NEGATIVE.” Would it be appropriate to assign ICD-10-CM code Z11.59 (encounter for screening for other viral diseases) for this?
CMS and the Centers for Disease Control and Prevention (CDC) announced a new ICD-10-CM code for reporting COVID-19 along with relief for facilities participating in quality reporting during COVID-19. Guidance on MS-DRG assignment and CC/MCC status for the new COVID-19 code has also been released.
Amy Sanderson, MD , writes that cerebral edema and brain compression are the result of significant brain abnormalities that can be life-threatening, and it’s important for clinicians to recognize and treat these conditions promptly. Properly documenting these diagnoses in the medical record is important to accurately reflect just how sick these patients are.
Sarah Nehring, CCS, CCDS, reviews ICD-10-CM reporting for the novel coronavirus (COVID-19) as well as ICD-10-PCS reporting for procedures such as mechanical ventilations, tracheostomies, and extracorporeal membrane oxygenations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Why delve into psychiatric record review? For some programs, the expansion into psychiatric units or facilities may be driven by the needs of the patient population, says Rhonda Mark, RN, BS, CCDS , a CDI specialist at Cleveland Clinic Indian River Hospital in Vero Beach, Florida.
Providence St. Joseph Health, which cared for the first U.S. novel coronavirus (COVID-19) patient, is sharing how the health system has responded to the crisis.
The Centers for Disease Control and Prevention (CDC) is monitoring the rapid spread of a disease caused by the 2019 novel coronavirus, formally named COVID-19 . Recently, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
Under both the 1135 waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS is increasing access to Medicare’s telehealth services to allow beneficiaries to receive professional healthcare services without having to travel to a healthcare facility.
The AMA announced that its CPT® editorial panel expedited approval of a unique CPT code to report laboratory testing services for COVID-19. The new code supports the urgent public health need for streamlined reporting of testing for the virus.
Providers will find immediate opportunity to provide virtual visits to patients enrolled in Medicare and Medicare Advantage plans as CMS seeks to facilitate screening and treatment of novel coronavirus (COVID-19) cases.
Approximately 12% of Americans suffer from migraine headaches, according to the Migraine Research Foundation. In this article, Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, reviews coding for migraine headaches and their treatment, including CPT reporting of drug-free alternative treatment options.
Given the frequency with which wound procedures are performed, and the expenses associated with their performance, it’s essential that coders have a clear understanding of how to accurately report CPT codes for these services. Review 2020 CPT codes for wound repairs and grafting procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We are seeing an influx of possible COVID-19 patients at our facility. How can we prepare to query for COVID-19-related documentation and coding issues that are bound to come our way due to the newness of the diagnosis?
